Organization
SPRUCE RUN - TH PROGRAM
Active
Organization
SPRUCE RUN - TH PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORATHY MARTEL (GRANTS)
(207) 945-5102
Entity
Organization
Contact information
Practice address
77 ESSEX, BANGOR, ME 04402
(207) 945-5102
(207) 990-4252
Mailing address
P.O. BOX 653, BANGOR, ME 04402-0653
(207) 945-5102
(207) 990-4252
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432212700
—
ME
Enumeration date
01/13/2009
Last updated
01/13/2009
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